Evaluation of environmental assessment tools for settings for individuals living with dementia

Introduction The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. Over the past three decades numerous environmental assessment tools have been developed in several countries, responding to a changing set of care industry values that increasingly prioritize a holistic, quality-of-life-driven person-centered care (PCC) model over a biomedical approach to long-term care (LTC) provision. This article reviews the diversity, constructs, strengths, and limitations of existing environmental assessment tools and identifies gaps for future tool development. Methods A systematic literature search was conducted using four databases (Medline, CINAHL, PsycInfo, and Avery Index) and terms related to health-care environments and assessment tools. Results A total of 13 environmental assessment tools for people living with dementia within shared residential settings were identified. Evaluation of the environmental assessment tools includes a synthesis of published data for each tool's reliability, validity, ease of use, interpretability, strengths and weaknesses, as well as a comparison of various tool characteristics including date of development, country of origin, applicable care setting(s), number and variety of measures and underlying constructs, format, and descriptive versus evaluative content. Discussion While the shift to person-centered values encompasses all aspects of care and care settings, the majority of person-centered definitions exclude the important role of the designed, physical environment. However, this review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of PCC values. In the United States, this is shown in the shift from tools designed to assess segregated dementia care settings to tools that integrate the needs and preferences both of individuals living with and without dementia. Next-generation tools need to specifically address the household model of design. Highlights The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. A systematic literature search identified a total of 13 environmental assessment tools for people living with dementia within shared residential settings; these tools were then described and evaluated based on reliability, validity, ease of use, interpretability, strengths, and weaknesses. This review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of person-centered care values.